Provider Demographics
NPI:1609085158
Name:BIERSACK, GINA MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:MARIE
Last Name:BIERSACK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 N M-37 HIGHWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:MIDDLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49333
Mailing Address - Country:US
Mailing Address - Phone:269-795-4400
Mailing Address - Fax:269-795-9670
Practice Address - Street 1:4525 N M-37 HIGHWAY
Practice Address - Street 2:SUITE A
Practice Address - City:MIDDLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:49333
Practice Address - Country:US
Practice Address - Phone:269-795-4400
Practice Address - Fax:269-795-9670
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019378122300000X, 1223G0001X
MI20259681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice